HomeMy WebLinkAboutWELL-11-2022-183806.TIF • CATAWBA COUNTY
Public Health Department Subdivision
Environmental health Division PINMI 460701289905
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2
Ca
Site Address: 3400 MT.PLEASANT RD,SHERRILLS FORD NC 28673
Name on Permit: GAVIN HOUCHINS
Property Size: Acres 15.450
Directions: from Newton take Hwy 16 south to Hwy 150,take 150 and travel east until you come to little mountain rd.
take left onto little mountain rd drive to Mt pleasant rd and make a right onto Mt pleasant rd the accross to the
property is 100 ft past dockside lane
. Owner/Authorized Representative Acknowledgement of Permit Receipt
6Ai t certify that I am the owner or authorized agent(owner's authorization required)representing the owner of
the property described above.
X6;1145s the property owner or authorized representative,I have received the above referenced
permit(s)as requested in the application for service RBPR-03-2022-40525,by the following method(s):
Received in Person
Facsimile Transmittal(Return form with signature required)
l Electronic Image Transmittal/E-mail (Return receipt required)
641 ttAs the property owner or authorized representative I have reviewed and understand the specific conditions
of the permit issued, and further understand that all applicable regulatory requirements specified under the
North Carolina Laws and Rules for Sewage Treatment and Disposal Systems(15A NCAC 18A.1900),
and/or Well Construction Standards(15A NCAC 2C.0100), shall apply to the issuance of this permit and
the construction of the wastewater system and/or water supply well permitted.
Permit Issue Date: 11/09/2022 /�
Owner/Authorized Representative Signature� 4( 6" •�••-•-
Date /1'' R-"ate
Documentation of Permit(s)Transmittal
(permit transmitted by electronic or other means)
Permit transmitted by (name of person sending permit)
Signature4E; Date/Time 1l f 7lb
Method: Fax ,f Email US Mail Other
Owner's request to send by the above indicated method of transmittal in lieu of signature
We wantt tto hear from youPlease flake a few momentts tto complette our custtomer service survey att
http://www.surveymonkey.com/s/EHCusttomerService
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„,„Hymn 11/11/2022 08:21
e CATAWBACOUNTY Case# WELL-I1-2022-I83806
it .t.a ,Z Public Health Department Subdivision
d - `-1 Environmental Health Division PIN# 460701289905
PO Box 389,25 Government Drive,Newton,NC 28658 LOT# 2
/8. a.
Site Address: 3400 MT. PLEASANT RD, SHERRILLS FORD NC 28673
Name on Permit: GAVIN HOUCHINS
Property Size: Acres 15.450
Directions: from Newton take Hwy 16 south to Hwy 150,take 150 and travel east until you come to little mountain rd.
take left onto little mountain rd drive to Mt pleasant rd and make a right onto Mt pleasant rd the accross to the
property is 100 ft past dockside lane
NEW WELL PERMIT
REQUIRED WELL SETBACKS:
Septic Systems and Repair Areas for Single Family Dwellings 50 ft.
Septic Systems and Repair Areas for Businesses and Multi-Family Residences 100 ft.
Underground Storage Tanks 100 ft.
Animal Barns 100 ft.
Lakes/Ponds 50 ft.
Streams/Brooks/Creeks/Rivers 25 ft.
Building Foundations 25 ft.
All Other Sources of Groundwater Contamination 100 ft.
Saprolite Septic Systems and Repair Areas 100 ft.
Septic Systems and Repair Areas to Wells with 2 or more connections 100 ft.
PERMIT CONDITIONS
Will be a shared well
Wells shall be constructed in accordance with state regulations:
Article 15A North Carolina Administrative Code Subchapter 2C
'l'he well driller must verify all setbacks before drilling the well. If the well driller is unable to maintain any of
the above setbacks,contact Catawba County Environmental Health at 828-465-8270,before drilling the well.
Grouting Depth:20 feet minimum
Casing Height: 12 inches minimum above finished grade
All newly constructed private drinking water wells arc required to be sampled in accordance with the North Carolina Rules Regarding Private
Drinking Water Well Testing(I5A NCAC 18A.3800).The fee for this sampling is included in the cost of the well permit.It is the applicant or
property owner's responsibility to notify Environmental Health when the well is ready for sampling.Water samples will be drawn from an
outside faucet unless otherwise specified.For questions or for more information,please contact Environmental Health.
4S; •HI ----- —.."-...7
11/08/2022
Authorized State Agent Permit Issuance Date
11/8/2027
Permit expiration Date
chpemiit I UI I/2022 08:24
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This map/report product was prepared from the Catawba County,NC Geospatial Information Services. Catawba County has made substantial efforts
to ensure the accuracy of location and information contained on this map or data on this report Catawba County promotes and recommends
the independent verification of any data on this map/report product by the user.The County of Catawba,its employees.agents,and
personnel,disclaim.and sh al not be held liable for any and al damages,loss or liabiity,whether direct,indirect or consequential whir} arises or may
arise from this mapheport product or the use thereof by any person or entity.
Copyright 2023 Catawba County NC
03/29/2023
n WPDT Report
Area of Interest (AOI) Information
Area : 3,134,508.7 ft2
Nov 8 2022 14:06:03 Eastern Standard Time
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Parcels(Polygons)-Parcels Protected Route 0 003 0.06 0.12
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— Feder&Route — Secondary Ro ite
— Non-System Primary Roads
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Ramps.Rest Areas,tdon.tdamyne — US Route d.otece.e.w.+.I..I TIN.sA users EPA MPS us Cal..MINIM/
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— NC Route
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All North Carolina Department of Environmental Quality(NCDEQ)GIS data is expressly provided"AS IS"and "WITH ALL FAULTS".The
NCDEQ makes no warranty of any kind,express or implied,concerning this information, including but not limited to any warranties of
merchantability or witness for any particular purpose.The NCDEQ assumes no responsibility or legal liability concerning the Data's accuracy,
reliability,completeness,timeliness,or usefulness,The data is not intended to constitute advice nor is it to be used as a substitute for specific
advice from a professional, Users should not act(or refrain from acting)based upon information in the Data without independently verifying
the information and obtaining any necessary professional advice. Users are solely responsible for ensuring the accuracy, currency and other
qualities of any products derived from or in connection with the NCDEQ's Data.The Data is collected from various sources and may be
modified over time without notice to improve spatial andattribute accuracy.The NCDEQ disclaims responsibility for the spatial accuracy and
attribution of GIS features and makes no warranty concerning same.
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Parcel: 460701289905, 3400 MT PLEASANT RD 1 in=100ft
SHERRILLS FORD, 28673
This map/report product was prepared from the Catawba County,NC Geospatial Irdrn motion Services. Catawba County has made substantial efforts
to ensure the accuracy of location and labeling information contained on this map or data on this report Catawba County promotes and recommends
the independent verification of any data contained on this map/report product by the user.The County of Catawba,Its employees,agents,and
personnel,disclaim,and shall not be held liable for any and all damages,loss or liability,whether direct,indirect or consequential which arises or may
arise from this map/report product or the use thereof by any person or entity,
Copyright 2021 Catawba County NC
11/08/2022
_.- .,tr-t ___.___.___.__ _. rnnl form
I Pi Ir;lcrn�it)rly ___ L
I.Well Contractor Information: ��`
Robert Teague - •______ _
well Contractor Nar x -- 14.trVATER ZONES - -
2857-A Fftovi to uFst xlPna�
S ft /U S rt. 1 ` -
Ni. V. i mtra,tet Ccrtificatron\'umM: - .___ _ ` YQm.__
B& K Well Drilling Inc 15.O1TfER CASING(for mujd{asid we OR LINP.RE a�•.-bh
I FROM
Company Name — -- _ Fes` —T_: To 5iaMFTfR THICKNESS MATERIAL
-- p ft. ft. t ----- -t
_ o I;d --in: SDR 2i PVC
2•Well Construction permit a: (� Z 3 16.LNNER CA ING OR TUB -
2. a llroA/t FROM •thermal dosed K .
wellcorutru;trortpermt:,ri r• ('fC•Coonn.Stoic l' — ---�O--_. DIAMEIF'R THICKNESS
ar;.rnre rt< 1 ft• - — MATERIAL
3.Well Use(check well use): /t. I In.' -
Water Supply Well:
rt' ft. 10
PPy ...17.SCREEN �_�----_-_
Agricultural FROM r0'
�hlunlcipaI;puhhi _— _ _f DIAMETER _SLOTSM.. THICKNESS MATERIAL
Geothermal(Heating/Cooling Cooltn Supply) _
5 pP ) ID Water Suppi}(single) -----(r ft. fn.
IndustriaUCotTunercial -+-__.-_.____.____� _
Residential Water Supply(shared) O I ft. in. I -
lrn anion PP y td GRO[Tf _-_. I - ---- -_
Non-Water Supply Well: Fnost TO Aj .MATERIAL E11PLACEm E NT METHOD&AMOUNT
Monitonng n• ft.
Injection Well: ❑Recovery -- - _- - -_ -- --- —ft. ft~
Aquifer Recharge ft ij - -
❑Groundwater Rcmcdiatron ft.
Aquifer Storage and Recover. I I-- ~_---
Salinity Barrier 19.SA:ND/GRAVEL PACK(if at able)
a Aquifer Test FROst ! TO MATERIAL EMPLACEMENT METHOD
❑Stormwater Drainage ft. I ft. `-
°Experimental Technology ❑Subsidence Control - ----
C]Geotherinal(Closed loop) 0 ft. i ft. I
Tracer 20.DRII.LLNG LOG(attach additional sheets IS aecasaty)
Geothermal(Heatinp/Coolin Return) Other(ex lain under#2I Remarks) FROM TO 4__
OF_[CRI,Tio.(color.birdmen,wit rya tip,.rain axe.etc.)
xr__t_ttssfll:Rc
4.Date Well(s)Completed:4` j -.."-,3 Aor.
Sa.Well Location: �
�h` ft. ft
13-F.�, I ft. ft.
13
Facility/tTvncr Name Facility IDe ft fapplicablcl
_ ) ft. ft.
`3--L-�- ( r �,sr� I ft. ft.
Physical Address.City.and Zip
K '�-" ft. ft.
____l ` 21.REMARKS
County Parcel Identification No.(PIN/
Sb.Latitude and longitude in degrees/minutes/seconds or decimal degrees: 1
(dwell field,one lat long is sufficient) _I
22.Certific lion:
N 1Y
6.Is(are)the well(s)IE)Permanent or °Temporary Ll+� `�j
SI turc of Certified ell Coy ctor Date
St
os form.I
7.Is this a repair Co an existing well: °Yes or o with opting
ISA YCAC 02C.0/00 orc 13 atls-rho,the CAC 02C I02190/Writ Cn urrucnant Standard'and
Ohs is a repair,fill out knoxr•wall construction in ormatinn o ofthis retard has been protidrd to the�rll or ner. n that a
repair under all remarks lertion or on the back of this form plain the rumor u/the top)
23.Site diagram or additional well details:
8.For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same You may use the back of this page to provide additional well site details or well
construction only is needed. Indicate TOTAL NUMBER of wells
construction details. You may also attach additional pages if necessary.
drilled:
SUBMITTAL INSTRUCTIONS
9.Total well depth below land surface: (ft)
1'ormdrrprexrw list arldeph„fdr�irenrruampre-i��o6-wid1 3/001 24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
10.Stade water level below top of casing: 40
limner10.Stlevel i, level
rasing.use -(f•) Division of Water Resources,Information Processing Unit,
6 1/8 1617 Mail Seniee Center,Raleigh,NC 27699-1617
I I.Borehole diameter. (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
12.well construction method: Air Rotary above,also submit one copy of this form within 30 days of completion of well
lie auger,rotary,cable,direct push.etc.) construction to the following:
FOR WATER SUPPLY WELLS ONLY: Division of Water Resources,Underground Injection Control Program,
1636 Mail Senice Center.Raleigh,NC 27699-1636
13a.Yield m Method of test: Au Flow
(YP ) 24c.For Water SuaoI•& Injection Wells: In addition to sending the form to
Chlor Tabs the address(es) above, also submit one copy
of 13b.Disinfection type: amount. 1 I`'LD' _
where constructed.completion of well construction to the county healththis form within 30 days of
department of the county
Fain w'l \onh Carolina Depart ment of Ern',unman,'Quality-Division of Water Rtsoueea Reviaod 222 2016
North Carolina Division of Public Health
Occupational and Environmental Epidemiology Branch,Epidemiology Section
BIOLOGICAL ANALYSIS REPORT
Private well water information and recommendations
County: Catawba, Name:�Q Gc"1^ �a.l'`�'�'^s Sample ID Number: d3
Location: �`'t OO Y} f lo- '-�t led J�° p r W W,b Qr.) Reviewer: Jason Boyd
Initial Sample k Confirmation Sample:
BIOLOGICAL ANALYSIS RESULTS AND RECOMMENDATIONS FOR USES OF YOUR
PRIVAl'h WELL WA1'bR(These recommendations are based on biological analysis only.)
No coliform bacteria were found in your well water.Your water can be used for all purposes
including drinking,cooking,washing dishes,bathing and showering.
Total coliform bacteria were detected in your water sample. Total Coliform are a group of related
bacteria that are(with few exceptions)not harmful to humans.A variety of bacteria,parasites, and
viruses,known as pathogens, can potentially cause health problems if humans ingest them.EPA considers
total coliforms a useful indicator of other pathogens for drinking water.Total coliforms are used to
determine the adequacy of water treatment and the integrity of the distribution system
It is recommended that your well water be re-tested to verify that the result is accurate.
Fecal coliform bacteria were detected in the sample.Do not use the water for drinking,
cooking,washing dishes,bathing or showering.
If the re-test shows contamination by bacteria contact your local health depai talent for assistance. There
may be a problem with the construction of the well,the groundwater source, or operation of the well.The
well needs to be inspected by the local health department or a local well contractor to determine the
problem with the well and to give guidance on how to correct the problem.
Your well water was tested for biological contaminants(total coliform and fecal coliform bacteria).The
results were evaluated using the federal drinking water standards.
Drinking water may contain substances that can occur naturally in water or can be introduced into water
from man-made sources. Total coliform bacteria are found in soil and fecal coliform bacteria are found in
animal and human waste.Total coliform or fecal coliform bacteria in well water indicate that the well
may have structural problems or that the well was not properly disinfected.
If you have been drinking the well water and are pregnant,nursing,have a child in the household under 5
years of age, or immunocompromised(such as an individual with AIDS, cancer,hepatitis,dialysis or
surgical procedures)inform your physician of these results at your next visit.
If the contamination continues,you should investigate the possibility of drilling a new well or installing a
point-of-entry disinfection unit which can use chlorine,ultraviolet light,or ozone.
For further information please contact your county health department or the Occupational and
Environmental Epidemiology Branch at 919-707-5900.
N 0 R T H C A R 0 L 1 N A
47.117f, a"* Private Well Information
, '1
kr
� � and Use Recommendations
NC DEPARTMENT OF
HEALTH AND HUMAN SERVICES
Division of Public Health For Inorganic Chemical Contaminants
County: Catawba Name: j-ou.k ;INS 3 Hoo On+, -4 /J
Sample ID#: Reviewer: Jason Boyd
TEST RESULTS AND USE RECOMMENDATIONS
1.jzsi Your well water meets federal drinking water standards for inorganic chemicals.Your water can be used for
drinking, cooking,washing, cleaning,bathing, and showering based on the inorganic chemical results only.You may
have other water sampling results that are not taken into account in this report.
2. ❑ The following substance(s)exceeded federal drinking water standards or the North Carolina 2L calculated health
levels.The North Carolina Division of Public Health recommends that your well water not be used for drinking and
cooking,unless you install a water treatment system to remove the circled substance(s).However,it may be used for
washing, cleaning,bathing and showering based on the inorganic chemical results only.
❑Arsenic n Barium n Cadmium ❑ Chromium ❑ Copper ❑Fluoride n Iron
n Lead ❑Manganese ❑Mercury n Nickel n Nitrate/Nitrite ❑ Selenium n Silver
n Zinc
3.❑ While your lead levels do not exceed federal or state standards,the North Carolina Division of Public Health has
concerns with any detection of lead. Should you have any questions please contact the NC Private Well and Health
Program at(919)707-5900.
4. ❑ Re-sample for lead and/or copper.Take a first draw and 30-second flush sample inside the house (preferably the
kitchen sink)and a first draw and 4 minutes flush sample at the wellhead to determine the source of lead and/or copper.
5. ❑ The following substance(s)exceeded aesthetic drinking water standards. Your water can be used for drinking,
cooking,washing,cleaning,bathing,and showering based on the inorganic chemical results only,but aesthetic problems
such as bad taste, odor, staining of porcelain, etc.may occur.You may want to install a household water treatment system
to address aesthetic problems.
❑ Chloride ❑ Copper ❑Fluoride ❑Iron ❑Manganese
❑ pII ❑ Silvcr ❑ Sulfate n Zinc
6. ❑ a. Sodium levels exceed the U.S.Environmental Protection Agency's(USEPA)Health Advisory level for sodium of
20 mg/1.The North Carolina Division of Public Health recommends that only individuals on no or low sodium-restricted
diets not use this water for drinking or cooking. It may be used for washing, cleaning,bathing,and showering based on
the inorganic chemical results only.
❑ b.Your sodium level exceeds 30 mg/1 and may pose aesthetic issues such as bad taste, odor, staining of porcelain, etc.
7. ❑Re-sampling is recommended in months,to reinvestigate
For more information regarding your well water results,please call the North Carolina Division of Public Health at 919-707-5900.